Think of the body as a gift as yet unopened, and we want to save the paper.
The totality of her care went well beyond my physical therapy visits. One month of undiagnosed diverticulitis led to another month in the hospital for surgery. While in the hospital, (nearly dying of sepsis) she unexpectedly lost (all-too-young) two members of her family and was unable to attend their services. During her home care physical therapy evaluation she was bed-bound, unable to roll to either side, sit unsupported, or stand without the help of 2 loved ones.
She was suffering from a form of non-organic dementia, cognitively there one moment, but gone the next. One minute she was discussing nuanced politics, the next she was screaming (often nonsense) in angst for reasons unknown (later) even to her. Pain from sutures in her abdomen increased her anxiety, her anxiety increased her vocalizations/distress and her distress significantly limited her participation in physical therapy.
Three weeks after beginning her care, she had made significant improvements. Cognitively, she was now “on” more than she was “off”. Motorically, she was nearly independent with bed mobility, could independently move her limbs in bed, was moving from sit to stand with only minimal to moderate assistance and taking a few short steps at her bedside. Despite all of this progress, she continued to have moments of distress, screaming out loud “Help me Jesus”, “Oh my God, make it stop”, and “Help me,” even when she was at rest. Her family shared that her screams persisted throughout the night; they were at their worst when her mind was unoccupied. When she had these moments, there was no training that could teach one human how to react and respond to another.
I am a physical therapist, not a psychiatrist, psychologist, or chaplain. When her hysteria would present, all I could do is to try to help calm her, place my hand on her leg or over her hand, gently stroke or pat her skin and remain silent; she would come back to me when she was ready.
While the patient spoke they were touched on the arm or the torso by the therapist and gently stroked or patted in a comforting manner. This seemed appropriate…I began to consider the messages of this kind of handling might give the patient. Things like, “I understand,” “I feel for you,” or “I’m so sorry you’re unhappy…”
Things continued much the same way every physical therapy visit: moments of success interrupted by moments of distress with my patient screaming out for something that she could not fully express.
One day, I changed my approach.
She became upset again, screaming aloud much as she had done every day before. This time I simply held her hand. The was no rubbing her leg, or patting her hand. I just rested both of my hands on hers. My mouth remained silent, my hands still.
…Then I began to consider some other possible messages, things like “calm down,” “stop that,” “I wish you are different,” and “be still.”…nobody actually says these things, their fingers do the talking. In this way the message passes unspoken from the body of the therapist to the felt sense of the patient. These messages are everywhere so nobody has to speak them.
Her screams gave way to uncontrollable weeping. After crying for nearly four minutes, she turned to me and (with a cracking voice), “I just want everyone to stop.”
With my hands still quietly resting on hers, “What do you want them stop?” I asked.
“I want everyone to stop talking, to stop trying to distract me. I want them to let me grieve…” her voice tailed off again as she began to sob once more. It was a breakthrough for her, the first time she had expressed her sorrow (in an understandable way).
. . . .
While I was driving to my next visit I wondered: was it possible that for three weeks my mouth had remained silent but my body was still talking? Is there a chance that in a very unintentional way, I had been making gestures to silence her not because she was uncomfortable or she was in distress, but rather because I was uncomfortable with her distress? Had I rubbed, stroked or patted in an effort to reduce her anxiety, or my own? Were my hands this day the first things that were quiet enough to give her permission to fully express herself without judgement? Was it the first time that someone’s hands and mouth were both saying the same thing?
I was wrong, we can be taught how to deal with circumstances such as these. That day, I learned to do nothing again.Quotes from an essay authored by Barrett Dorko, PT titled ‘Wake Up Call’